Download Stool Softeners for the Prevention and Management of

July 2014
Stool Softeners for the Prevention and Management of Constipation:
A Review
Context
Methods
Although definitions of constipation vary, it is often
described as a reduced frequency of bowel
movements to fewer than three times per week or by
symptoms that include difficulty passing stools, hard
stools, abdominal cramping, and incomplete stool
passage. Constipation may be idiopathic, with no
known cause, or it can be caused by diet, medication,
or medical conditions. An estimated 2% to 27% of the
general population is affected by constipation, and
chronic constipation is much more common in the
elderly and in patients taking opioids.
A limited literature search was conducted of key
resources, and titles and abstracts of the retrieved
publications were reviewed. Full-text publications
were evaluated for final article selection according to
predetermined selection criteria (population,
intervention, comparator, outcomes, and study
designs).
Technology
Current treatment options for constipation include
dietary or bulking agents (i.e., psyllium seed husk),
osmotic laxatives (i.e., lactulose, sorbitol,
polyethylene glycol [PEG]), stimulant laxatives (i.e.,
sennosides, bisacodyl, sodium picosulfate), and stool
softeners (i.e., docusate sodium or docusate calcium).
In North America, a stool softener and a stimulant
laxative are commonly used in bowel treatment
protocols for institutionalized elderly and oncology
patients.
Issue
Given how frequently stool softeners are prescribed
in everyday clinical practice and despite the low cost
of these medications, a review of the clinical
effectiveness of docusate will help to inform decisions
about the prevention and management of
constipation.
Key Messages
For the prevention and management of
constipation:
 There is little evidence to support the use of
docusate in hospitalized patients or long-term
care residents.
 Docusate does not increase stool frequency or
soften stools compared with placebo.
 Docusate does not improve the symptoms of
constipation.
 Docusate does not improve the difficulties or
completeness of stool evacuation in patients
taking opioids.
Results
The literature search identified 367 citations, 15 of
which were deemed potentially relevant. An
additional 3 articles were retrieved from other
sources. Of these 18 studies, 5 met the criteria
for inclusion in this review: 2 systematic reviews,
1 randomized controlled trial, and 2 non-randomized
studies.
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